Featured Research

from universities, journals, and other organizations

Elimination of Medicare three-day rule could reduce risks costs of unnecessary hospitalizations

Date:
September 16, 2013
Source:
Beth Israel Deaconess Medical Center
Summary:
Elimination of a Medicare rule that mandates a three-night hospital stay as a precondition for skilled nursing rehabilitation coverage could reduce unnecessary hospitalizations and improve patient care without increasing costs to the patient or the federal government.

Elimination of a Medicare rule that mandates a three-night hospital stay as a precondition for skilled nursing rehabilitation coverage could reduce unnecessary hospitalizations and improve patient care without increasing costs to the patient or the federal government, a leading geriatrician asserts in on online publication of the Journal of the American Medical Association.

"Rather than rely on the three-night stay to identify appropriate patients for skilled nursing and rehabilitative services, the Centers for Medicare and Medicaid Services (CMS) could implement specific functional criteria … such as acute decline in mobility, impairment of activities of daily living or presence of delirium, and use the savings from reduced hospitalizations to provide appropriate payments for home-based or nursing home-based treatments," writes Lewis Lipsitz, MD, Chief of Gerontology at Beth Israel Deaconess Medical Center and Director of the Institute for Aging Research and a Professor of Medicine at Harvard Medical School in a JAMA "Viewpoint ."

This could be paired with a shared-savings model like the current move to quality contracts and accountable care organizations that, when used in conjunction with efficient case management and quality controls, can provide appropriate saving incentives.

The three-night stay rule was established in 1965, when it typically took three days for a Medicare patient to be admitted and evaluated, have a care plan developed and be discharged. The process now takes only a day or two.

Over the years, waivers of the rule were allowed. Studies suggested the waiver had little effect on the quality of patient care and that small financial savings could be achieved.

However a review after passage of the short-lived Medicare Catastrophic Care Act of 1988 found a 243 percent increase in Medicare spending attributed to an increase in volume in skilled nursing facility (SNF) care.

"Without the three-night stay requirement, nursing homes may have triggered the SNF benefit for changes in condition that were previously managed with customary nursing home services," notes Lipsitz.

The rule was reinstated after the law's 1989 repeal and has generated continued debate. Former CMS Administrator Donald Berwick recently called for the rule's elimination as one way to clarify confusion surrounding the classification of "inpatient" versus "observation" patients.

Lipsitz notes the current rule "may create incentives to hospitalize patients unnecessarily." And while he acknowledges "there is little empirical evidence that elimination of the three-night stay rule will improve patient care without increasing Medicare costs, there is justifiable concern that this rule contributes to suboptimal care and increased costs attributable to avoidable hospitalizations.

For example, he cites hypothetical cases where a patient who needs rehabilitation after a fall at home is admitted to a hospital to be eligible for skilled nursing care -- or where a patient is transferred from a nursing home to a hospital to relieve an overburdened licensed practical nurse -- at a significantly higher cost.

While agreeing with the "imperative to reduce excessive use of hospitals and provide appropriate care in less expensive venues, (t)his national priority should be consistent with an effort to eliminate the three-night stay requirement and provide enhanced care for older patients wherever they live -- in the community or in a nursing home," Lipsitz writes.


Story Source:

The above story is based on materials provided by Beth Israel Deaconess Medical Center. Note: Materials may be edited for content and length.


Journal Reference:

  1. Lewis A. Lipsitz. The 3-Night Hospital Stay and Medicare Coverage for Skilled Nursing CareThe 3-Night Hospital Stay and Medicare CoverageViewpoint. JAMA, 2013; DOI: 10.1001/jama.2013.254845

Cite This Page:

Beth Israel Deaconess Medical Center. "Elimination of Medicare three-day rule could reduce risks costs of unnecessary hospitalizations." ScienceDaily. ScienceDaily, 16 September 2013. <www.sciencedaily.com/releases/2013/09/130916143228.htm>.
Beth Israel Deaconess Medical Center. (2013, September 16). Elimination of Medicare three-day rule could reduce risks costs of unnecessary hospitalizations. ScienceDaily. Retrieved August 30, 2014 from www.sciencedaily.com/releases/2013/09/130916143228.htm
Beth Israel Deaconess Medical Center. "Elimination of Medicare three-day rule could reduce risks costs of unnecessary hospitalizations." ScienceDaily. www.sciencedaily.com/releases/2013/09/130916143228.htm (accessed August 30, 2014).

Share This




More Health & Medicine News

Saturday, August 30, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

3 Things To Know About The Ebola Outbreak's Progression

3 Things To Know About The Ebola Outbreak's Progression

Newsy (Aug. 29, 2014) Here are three things you need to know about the deadly Ebola outbreak's progression this week. Video provided by Newsy
Powered by NewsLook.com
Killer Amoeba Found in Louisiana Water System

Killer Amoeba Found in Louisiana Water System

AP (Aug. 28, 2014) State health officials say testing has confirmed the presence of a killer amoeba in a water system serving three St. John the Baptist Parish towns. (Aug. 28) Video provided by AP
Powered by NewsLook.com
Who Could Be Burnt by WHO's E-Cigs Move?

Who Could Be Burnt by WHO's E-Cigs Move?

Reuters - Business Video Online (Aug. 28, 2014) The World Health Organisation has called for the regulation of electronic cigarettes as both tobacco and medical products. Ciara Lee looks at the impact of the move on the tobacco industry. Video provided by Reuters
Powered by NewsLook.com
CDC Director On Ebola Outbreak: 'It's Worse Than I Feared'

CDC Director On Ebola Outbreak: 'It's Worse Than I Feared'

Newsy (Aug. 28, 2014) CDC director Tom Frieden says the Ebola outbreak is even worse than he feared. But he also said there's still hope to contain it. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins